Objective

Cardiac surgery is one of the leading users of blood and blood products. During surgery, cardiopulmonary bypass (CPB) is associated with dilution and contact coagulopathies, despite advances in technology. Conventional red cell salvage may exacerbate postoperative bleeding, as all coagulation factors are discarded. A novel cell salvage device (HemoSep), that retains all cell species, may attenuate coagulation disorders. This study compares coagulation markers in patients' blood following shed and residual pump blood processing.

Method

This randomised controlled trial compared coagulation markers in CABG or AVR patients receiving autologous blood returned from cell salvage or HemoSep. Blood samples were taken preoperatively, end of CPB, post-transfusion of salvaged blood, and 3 hours post-operatively, and analysed for full blood count (FBC), Prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, DDimer, endogenous thrombin potential (ETP) and platelet function and compared between groups.

Results

54 patients were recruited (n=28 control,n=26 study). Cell saver volume was significantly (p<0.001) higher in the study group. In study group, PT was shorter (18.7±0.3vs19.9±0.3; p<0.05) postoperatively, and aPTT was increased (48.6±3.8vs37.3±1.0; (p<0.01) following autologous transfusion. In control group, D-Dimer and ETP were higher (1903±424vs1088±151; p<0.05 and 739±46vs394±60; p<0.001 respectively) following autologous transfusion.

Conclusion

The HemoSep device demonstrated minor benefits In terms of coagulation when used in low-risk cardiac surgery patients. Although centrifuged cell salvage is known to adequately haemoconcentrate, and to remove unwanted substrates and bacteriological contamination, the process can cause dilutional and consumption coagulopathy along with a hyperfibrinolytic state that use of HemoSep may avoid.